Conservative Rehabilitation Provides Superior Clinical Results Compared to Early Aggressive Rehabilitation for Rotator Cuff Repair: A Retrospective Comparative Study

Background and objectives: To compare the long term clinical outcomes, range of motion (ROM) and strength of two different postoperative rehabilitation protocols after arthroscopic rotator cuff repair (RCR) for full-thickness rotator cuff (RC) tears. Materials and Methods: Patients undergoing RCR were divided into two groups. In 51 patients (56 shoulders), rehabilitation was performed without passive external rotation, anterior elevation ROM, and active pendulum exercises in the first 2 weeks after surgery (Group A). In 49 patients (50 shoulders) aggressive rehabilitation was implemented, with early free passive external rotation, anterior elevation ROM, and active pendulum exercises were allowed from the day after surgery (Group A). Results: No statistically significant differences were found in clinical scores, muscle strength, passive forward flexion, passive and active internal/external rotation between the two groups. However, the mean active forward flexion was 167.3° ± 26° (range 90–180°) in group A and 156.5° ± 30.5° (range 90–180°) in group B (p = 0.04). Conclusions: A statistically significant difference between the 2 groups was found in active forward flexion ROM, which was better in patients of group A.

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Short-term Comparison of Supervised Rehabilitation and Home-based Rehabilitation for Earlier Recovery of Shoulder Motion, Pain, and Function after Rotator Cuff Repair

Clinics in Shoulder and Elbow ◽

10.5397/cise.2018.21.1.15 ◽

2018 ◽

Vol 21 (1) ◽

pp. 15-21

Author(s):

Si Jung Song ◽

Tae Ho Jeong ◽

Jung Wha Moon ◽

Han Vit Park ◽

Si Yung Lee ◽

...

Keyword(s):

Rotator Cuff ◽

Internal Rotation ◽

Rotator Cuff Repair ◽

External Rotation ◽

Exercise Group ◽

Short Term ◽

Forward Flexion ◽

Supervised Exercise ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

BACKGROUND: This study was undertaken to compare the outcome of supervised and home exercises with respect to range of motion (ROM), pain, and Single Assessment Numeric Evaluation (SANE). We further correlated the ROM recovery and pain reduction as well.METHODS: The study included 49 patients who underwent arthroscopic rotator cuff repair. Rehabilitation was initiated after 4 weeks of immobilization. A total of 29 patients performed supervised exercise 3 times a week. Standardized education and brochures for review were provided to the remaining 20 patients who insisted on home rehabilitation. Statistical analysis was performed for comparing pain Numerical Rating Scale (NRS), SANE, and ROM. In addition, we also evaluated the correlation between pain and ROM.RESULTS: Comparison of the two groups revealed no significant differences in forward flexion, internal rotation, abduction, and pain NRS. However, SANE at the 9th week (63.8 vs. 55.0, p=0.038) and improvement of external rotation from the 5th to the 9th week (17.6 vs. 9.3, p=0.018) were significantly higher in the supervised exercise group as compared to the home exercise group. Correlation of pain NRS with forward flexion, external rotation, internal rotation and abduction were statistically not significant (correlation coefficient=0.032 [p=0.828], ?0.255 [p=0.077], 0.068 [p=0.642], and ?0.188 [p=0.196], respectively).CONCLUSIONS: The supervised rehabilitation after arthroscopic rotator cuff repair showed better improvement in external rotation and higher SANE score after 4 weeks of rehabilitation exercise. However, no statistically significant correlation was observed between the recovery of ROM and short-term pain relief.

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The Effect of Acromioplasty or Bursectomy on the Results of Arthroscopic Repair of Full Thickness Rotator Cuff Tears: Does the Acromion Type Affect These Results?

10.21203/rs.3.rs-28313/v1 ◽

2020 ◽

Author(s):

Ozgun Karakus ◽

Ahmet Sinan Sari

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Subacromial Decompression ◽

Significant Difference ◽

Group A ◽

Decompression Procedure ◽

Group B ◽

Cuff Repair

Abstract Introduction: The aim of this study was to investigate the effect of subacromial decompression on the results of full thickness rotator cuff repair applied arthroscopically. Examination was also made of the effect of acromion type on the subacromial decompression procedure in patients applied with arthroscopic rotator cuff repair. Materials and Methods: The study included a total of 150 patients, comprising 102 (68%) females and 48 (32%) males with a full thickness rotator cuff tear repaired arthroscopically. The patients were separated into 3 groups of 50. Group A comprised those with acromioplasty and bursectomy applied additional to the repair. In Group B, only bursectomy was performed additional to the repair and in Group C, only rotator cuff repair was applied. Evaluation was made of the postoperative long-term pain and functional results. Results: The mean age of the cases was 65.63±9.22 years (range, 46-86 years). The affected side was right side in 95 (63.3%) cases and left side in 55 (36.7%). No statistically significant difference was determined between the groups according to the postoperative Constant Murley and ASES scores (p>0.05). In the paired comparisons, the postoperative VAS scores of Group C were higher than those of Groups A and B (p=0.018, p=0.029, p<0.05). No statistically significant difference was determined between Group A and Group B in respect of the postoperative VAS scores (p>0.05). Conclusions: In the arthroscopic repair of full thickness rotator cuff tears, neither acromioplasty, coraco-acromial ligament loosening nor bursectomy were determined to have any positive effect on the results. Whatever the acromion type, there is no need for an additional subacromial decompression procedure after rotator cuff repair, in respect of pain and functional outcomes. Only acromial spurs should be gently removed paying attention to the coraco-acromial ligament.

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Platelet Rich Plasma in Arthroscopic Rotator Cuff Repair: Clinical and Radiological Results of A Prospective RCT Study at 10-Year Follow-Up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00245 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0024

Author(s):

Pietro Randelli ◽

Carlo Alberto Stoppani ◽

Elisabetta Nocerino ◽

Alessandra Menon ◽

Riccardo Compagnoni

Keyword(s):

Surgical Treatment ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

External Rotation ◽

Platelet Rich Plasma ◽

Arthroscopic Rotator Cuff Repair ◽

Significant Difference ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Objectives: Despite the technical advancement in arthroscopic rotator cuff repair, inadequate healing or retear of the repaired rotator cuff frequently occurs. The use of biological factors in the surgical treatment has been proved to be effective to enhance tendon healing in the post-operative period. The aim of the study is to compare clinical and radiological outcomes of arthroscopic rotator cuff repair with or without the addition of platelet-rich plasma (PRP) at 10-year follow-up. Methods: Of 53 patients recruited in the study, and randomly divided into two groups (PRP=26; control=27), 38 were re-evaluated at least 10 years after the index procedure. The clinical evaluation was carried out through: University of California at Los Angeles (UCLA) Shoulder Score, Visual Analogue Scale (VAS), Simple Shoulder Test (SST), Constant-Murley Score (CMS), Single Assessment Numerical Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) and isometric strength in abduction and external rotation. Musculoskeletal ultrasound had been used to evaluate the integrity of the repaired cuff. Results: A number of 38 (71%) patients (PRP=17; control=21) with a median age of 71 [64.75-76.50] years have been evaluated. Satisfaction at follow-up is high (90%), without statistically significant difference between the two groups. We report good and excellent clinical results in both groups (PRP vs control): CMS (81.62 [72.47-85.75] vs 77.97 [69.52-82.55] points), UCLA (34 [29.00-35.00] vs 33 [29.00-35.00] points), VAS (0.34 [0.00-1.85] vs 0.70 [0.00-2.45] cm), ASES (100.00 [94.17-100.00] vs 93.33 [68.33-100.00] points), SANE (100 [80-100] vs 80 [70-90] points), SST (12.00 [11.00-12.00] vs 12.00 [9.00-12.00] points),shoulder abduction strength (3.92 ± 2.30 vs 3.20 [1.72-4.65] kg), shoulder external rotation strength (5.31 ± 2.77 vs 4.36 ± 2.05 kg). It was not possible to find a statistically significant difference for the variables analysed, except for few subjective variables (ASES, SANE). On average, 37% of the operated patients had a re-rupture at the ultrasound examination, with no significant difference between the two groups (p=1.00). Compared with the previous radiological control at the 2-year follow-up, new retears occurred in 6% of the patients that received PRP treatment, whereas in the control group the percentage raises to 14% (p=0.61). Conclusions: The clinical and radiological outcomes at the 10-year follow-up show a substantial uniformity of results between the two groups. The clinical differences that had been observed at 2-year follow-up disappeared at long term. A reduction in retear rate is observed at US evaluation in the PRP group at 10 years follow-up and this trend needs to be further analyzed. Patients’ satisfaction is still high 10 years after surgical treatment, in both groups.

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In Arthroscopic Rotator Cuff Surgery, is there a Difference in the Results of Repair made with Single or Double Rows according to the Shape and Size of the Tear?

10.21203/rs.3.rs-61030/v1 ◽

2020 ◽

Author(s):

Ozgun Karakus ◽

Ozgur Karaman ◽

Ahmet Sinan Sari ◽

Baransel Saygi

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Functional Results ◽

Double Row ◽

Single Row ◽

Significant Difference ◽

Group A ◽

Double Row Repair ◽

Cuff Repair ◽

Shape And Size

Abstract Background: The aim of this study was to evaluate the effect on the results of patients applied with arthroscopic full layer total layer rotator cuff repair made according to the shape and size of the tear.Methods: The study included a total of 120 patients applied with arthroscopic full layer rotator cuff repair as single or double row repair, comprising 69 (57.5%) females and 51 (42.5%) males. The patients were separated into 3 groups of 40 according to the shape of the tear, as Group A (crescent type), Group B (U type), and Group C (L type). Within each group, classification was made according to the size of the tear. The long-term postoperative functional results were compared between the groups. Results: The mean age of the whole sample was 66.68±6.86 years (range, 50-81 years). A statistically significant difference was determined between the groups in respect of Constant Murley (CM), ASES, and UCLA scores (p<0.05). The scores of Group A of all the scales were found to be higher than those of Group C (p<0.05). In single row and double row repair of small and medium-sized tears of all shapes, no significant difference was determined in respect of the CM and UCLA scores (p>0.05). In the large tears, no significant difference was determined between crescent and U-shaped tears in respect of the CM and UCLA scores (p>0.05). Conclusions: No significant difference was determined between single and double row repair of crescent type tears of all sizes. In the repair of small and medium-sized U type tears, no significant difference was determined between single and double row repair in respect of the CM and UCLA scores. In large U-shaped tears, the CM, ASES, and UCLA scores were determined to be high in double row repair. No significant difference was determined between single and double row repair of L type small and medium-sized tears. In the large L -shaped tears, the results of the single row repair were found to be higher than those of the cases with double row repair.

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Outcomes Following the Repair of Isolated Supraspinatus Repairs versus those with Concurrent Subscapularis Repairs (242)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00350 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0035

Author(s):

Emily Whicker ◽

Jonathan Hughes ◽

Jacob Puyana ◽

Neel Patel ◽

Edna Fongod ◽

...

Keyword(s):

Rotator Cuff ◽

Outcome Measures ◽

Rotator Cuff Repair ◽

External Rotation ◽

Patient Reported Outcome Measures ◽

Rotator Cuff Tears ◽

Supraspinatus Tear ◽

Significant Difference ◽

Patient Reported ◽

Cuff Repair

Objectives: While rotator cuff tears often require repair of the supraspinatus, patients can also have a concurrent tear of the subscapularis requiring repair. Previous smaller studies have shown good clinical outcomes following the repair of the subscapularis and rotator cuff during the same procedure.1 The purpose of this study was to compare clinical outcome measures between patients who had isolated supraspinatus repairs versus those who had a supraspinatus tear with a concurrent subscapularis repair. Methods: A retrospective review of 166 patients who underwent arthroscopic supraspinatus repair with or without a concurrent subscapularis repair between 2013-2018 with a minimum of one-year follow up was performed. Patients were separated into two groups based on their treatment: 100 had an isolated supraspinatus repair (SP) and 66 had both a supraspinatus and subscapularis repair (SB). The primary outcome was revision rotator cuff repair. Secondary outcomes were objective measures such as range of motion (ROM) and strength testing, including flexion (FF), external rotation (ER), and internal rotation (IR), as well as patient-reported outcome measures (PROs) including visual analog pain scale (VAS) and subjective shoulder value (SSV). Outcomes were compared using the Mann- Whitney Test and Fisher’s Exact Test with p<0.05, as the data were not parametric (SPSS, IBM). Results: There was no significant difference in the rate of revision surgery required following isolated supraspinatus repair versus those with a subscapularis repair. Additionally, there were no significant differences between groups for all PROs, all ROM parameters, and all strength parameters (all p > 0.05) (Table 1). Conclusions: The data from this study demonstrated that patients who require a subscapularis repair at the time of their rotator cuff repair can expect similar short term outcomes to those patients who only required repair of their supraspinatus.

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In Arthroscopic Rotator Cuff Surgery, Is There a Difference in the Results of Repair Made With Single or Double Rows According to the Shape and Size of the Tear?

10.21203/rs.3.rs-146662/v1 ◽

2021 ◽

Author(s):

Ozgun Karakus ◽

Ozgur Karaman ◽

Ahmet Sinan Sari ◽

Baransel Saygi

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Functional Results ◽

Double Row ◽

Single Row ◽

Significant Difference ◽

Group A ◽

Double Row Repair ◽

Cuff Repair ◽

Shape And Size

Abstract IntroductionThe aim of this study was to evaluate the effect on the results of patients applied with arthroscopic full layer total layer rotator cuff repair made according to the shape and size of the tear.Materials and MethodsThe study included a total of 120 patients applied with arthroscopic full layer rotator cuff repair as single or double row repair, comprising 69 (57.5%) females and 51 (42.5%) males. The patients were separated into 3 groups of 40 according to the shape of the tear, as Group A (crescent type), Group B (U type), and Group C (L type). Within each group, classification was made according to the size of the tear. The long-term postoperative functional results were compared between the groups. ResultsThe mean age of the whole sample was 66.68±6.86 years (range, 50-81 years). A statistically significant difference was determined between the groups in respect of Constant Murley (CM), ASES, and UCLA scores (p<0.05). The scores of Group A of all the scales were found to be higher than those of Group C (p<0.05). In single row and double row repair of small and medium-sized tears of all shapes, no significant difference was determined in respect of the CM and UCLA scores (p>0.05). In the large tears, no significant difference was determined between crescent and U-shaped tears in respect of the CM and UCLA scores (p>0.05).ConclusionsNo significant difference was determined between single and double row repair of crescent type tears of all sizes. In the repair of small and medium-sized U type tears, no significant difference was determined between single and double row repair in respect of the CM and UCLA scores. In large U-shaped tears, the CM, ASES, and UCLA scores were determined to be high in double row repair. No significant difference was determined between single and double row repair of L type small and medium-sized tears. In the large L -shaped tears, the results of the single row repair were found to be higher than those of the cases with double row repair.

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Is It Safe to Inject Corticosteroids Into the Glenohumeral Joint After Arthroscopic Rotator Cuff Repair?

The American Journal of Sports Medicine ◽

10.1177/0363546519843910 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1694-1700 ◽

Cited By ~ 6

Author(s):

Yang-Soo Kim ◽

Hong-Ki Jin ◽

Hyo-Jin Lee ◽

Hyung-Lae Cho ◽

Wan-Seok Lee ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Glenohumeral Joint ◽

External Rotation ◽

Significant Difference ◽

Group 2 ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Group 1

Background: Injection of intra-articular corticosteroids is effective for improving the recovery of range of motion (ROM) and pain in various conditions of the shoulder but its use is limited after rotator cuff repair owing to concern over the possible harmful effects of steroids on the repaired tendon. Purpose: To evaluate the effect of intra-articular corticosteroid injections on the clinical outcomes and cuff integrity of patients after rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Between March 2011 and April 2014, 80 patients with a small- to medium-sized rotator cuff tear were enrolled in this study and underwent arthroscopic rotator cuff repair. Forty patients received an injection of triamcinolone (40 mg) and lidocaine (1.5 mL) into the glenohumeral joint 8 weeks after surgery (group 1), while the remaining 40 patients received normal saline injection (group 2). Outcome measures—including ROM, American Shoulder and Elbow Surgeons (ASES) score, Constant score, pain visual analog scale, and Simple Shoulder Test score—were evaluated at 3, 6, and 12 months after surgery and at the last follow-up. The integrity of the repaired tendon was evaluated by magnetic resonance imaging (MRI) and classified per Sugaya classification at 8 weeks (before injection) and 12 months after surgery. Results: The mean follow-up period was 25.7 months. At 3 months postoperatively, patients in group 1 had a significantly higher ROM with respect to forward flexion ( P = .05), external rotation at the side ( P = .05), and external rotation at abduction ( P = .04) as compared with group 2, whereas no significant difference was noted between the groups for internal rotation behind the back ( P = .65). Patients in group 1 had significantly lower visual analog scale pain scores ( P = .02) and higher ASES scores (group 1, 68.90; group 2, 60.28; P = .02) at 3-month follow-up. However, there was no significant difference after 6 months with respect to ROM and ASES scores (group 1, 77.80; group 2, 75.88; P = .33). Retears (Sugaya classification IV and V) were determined by MRI at 12 months and observed in a total of 7 patients (8.8%): 3 from group 1 (7.5%) and 4 from group 2 (10%). No retears were observed on MRI in the remaining 73 patients (91.2%): 37 patients from group 1 and 36 patients from group 2. There was no statistically significant difference in rate of retears between groups ( P = .69). Conclusion: Intra-articular injection of corticosteroids after rotator cuff repair does not increase the risk of retears and is thus an effective and safe treatment method for increasing ROM (forward flexion, external rotation) and improving clinical score (ASES) during the early postoperative period of patients undergoing rotator cuff repair.

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Can a Double-Row Anchorage Technique Improve Tendon Healing in Arthroscopic Rotator Cuff Repair?

The American Journal of Sports Medicine ◽

10.1177/0363546507301661 ◽

2007 ◽

Vol 35 (8) ◽

pp. 1247-1253 ◽

Cited By ~ 176

Author(s):

Christophe Charousset ◽

Jean Grimberg ◽

Louis Denis Duranthon ◽

Laurance Bellaiche ◽

David Petrover

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Constant Score ◽

Tendon Healing ◽

Clinical Results ◽

Level Of Evidence ◽

Double Row ◽

Single Row ◽

Significant Difference ◽

Cuff Repair

Background Increasing the rate of watertight tendon healing has been suggested as an important criterion for optimizing clinical results in rotator cuff arthroscopic repair. Hypothesis A double-row anchorage technique for rotator cuff repair will produce better clinical results and a better rate of tendon healing than a single-row technique. Study Design Cohort study; Level of evidence, 2. Methods We compared 31 patients undergoing surgery with a double-row anchorage technique using Panalok anchors and Cuff Tack anchors and 35 patients with rotator cuff tear undergoing surgery with a single-row anchorage arthroscopic technique using Panalok anchors. We compared pre- and postoperative Constant score and tendon healing, as evaluated by computed tomographic arthrography 6 months after surgery, in these 2 groups. Results The Constant score increased significantly in both groups, with no difference between the 2 groups (P = .4). Rotator cuff healing was judged anatomic in 19 patients with double-row anchorage and in 14 patients with single-row anchorage; this difference between the groups was significant (P = .03). Conclusion In this first study comparing double- and single-row anchorage techniques, we found no significant difference in clinical results, but tendon healing rates were better with the double-row anchorage. Improvements in the double-row technique might lead to better clinical and tendon healing results.

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Outcomes of Accelerated Physical Therapy in Patients with Transtendinous Rotator Cuff Repair (234)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00342 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0034

Author(s):

Trevor McBroom ◽

Paul Abraham ◽

Nathan Varady ◽

Michael Kucharik ◽

Evan O’Donnell ◽

...

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Rotator Cuff Repair ◽

External Rotation ◽

Smoking Status ◽

Control Cohort ◽

Forward Flexion ◽

Early Motion ◽

Strengthening Exercises ◽

Cuff Repair

Objectives: Surgical treatment options for the repair of symptomatic partial thickness and minimally retracted full-thickness rotator cuff tears include transtendinous or tear-completion transosseous-equivalent approaches. While transtendinous repairs are associated with superior biomechanical outcomes and lower rates of cuff re-tear, they have been linked to greater stiffness and a slower rate of recovery in comparison to tear-completion transosseous-equivalent repairs, especially in the first three months postoperatively. The purpose of this retrospective matched cohort study was to examine whether expediting a patient’s physical therapy (PT) regimen immediately following transtendinous rotator cuff repair can avert complications of postoperative stiffness and improve range of motion. Methods: After institutional review board approval, the medical records of all patients who underwent arthroscopic rotator cuff repair by the senior author between March of 2015 and May of 2019 were reviewed for inclusion in the study. Inclusion criterion was transtendinous repair. Patients that underwent an accelerated PT regimen were compared to a historical control cohort. The accelerated rehabilitation cohort was allowed passive range of motion (PROM) at 2-4 weeks, active-assisted range of motion (AAROM) at 2-4 weeks, active range of motion (AROM) at 4-6 weeks and strengthening exercises at 6-8 weeks. The historical control cohort received transtendinous rotator cuff repair between February 2005 and February 2015, and subsequently underwent a standard postoperative protocol with no shoulder motion until 6 weeks, PROM at 6-12 weeks, and AROM and strengthening exercises at 3-6 months. These cohorts were propensity matched for age, sex, BMI, and smoking status (with exact matches for sex and smoking status). Medical charts were reviewed for arthroscopic findings, including the tendons repaired (supraspinatus, infraspinatus, subscapularis, or a combination), arthroscopic classification of the tear thickness (partial, high-grade partial, focal full, or full), and presence of a concurrent labral tear. Patient data were analyzed with a mixed effects model to evaluate differences in active ROM at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Forward flexion, abduction, and external rotation were recorded in degrees. Internal rotation was converted from vertebral levels to the Constant Shoulder Score’s numerical ten-point scale for analysis. Finally, re-tear complications were recorded at final follow-up of 6 months and then analyzed with Fisher’s exact test. Results: Sixty-one accelerated PT patients and 61 standard PT controls were included in the study. Mean age (57.02 ±2.70 years [95% confidence interval] vs. 57.45 ± 2.78 years, p=0.83), BMI (28.13 ± 1.13 kg/m2 vs. 28.28 ± 0.99 kg/m2, p=0.84), sex (61.66% female vs. 61.66% female p=1.00), and smoking status (p=1.00) were similar between groups. There were no significant differences between groups in the tendons repaired, the arthroscopic tear thickness, nor the presence of labral tears. (Table 1). The accelerated PT cohort showed significantly increased AROM at 6 weeks and 3 months postoperatively. At 6 weeks, ROM in forward flexion (136.97° vs. 110.52°; p<0.001), abduction (126.08° vs. 100.73°; p=0.003), and external rotation (51.65° vs. 37.90°; p=0.009) were all significantly higher in the accelerated PT cohort. A similar increase was seen at 3 months, with superior forward flexion (147.47° vs. 132.84°; p=0.009), abduction (140.44° vs. 121.91°; p=0.02), and external rotation (57.70° vs. 40.76°; p=0.001) in patients who received accelerated PT. With the exception of forward flexion, which was improved in the accelerated cohort (151.32° vs. 139.11°; p=0.04), there were no other differences in active ROM at 6 months. Internal rotation metrics approached statistical significance at 2 and 6 weeks postoperatively (p=0.07 and p=0.06, respectively). There were no re-tears (0.00%) in the accelerated PT cohort and 1 re-tear (1.64%) in the standard PT cohort (p=1.00). (Table 2). Conclusions: Accelerated PT following transtendinous rotator cuff repair is associated with substantial improvement in AROM at 6 weeks and 3 months when compared to standard PT protocols. Further, the early motion does not seem to result in a higher rotator cuff re-tear rate. Thus, early motion and liberation from obligate sling wear may reduce stiffness and be better tolerated following transtendinous rotator cuff repair surgery.

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Delayed Rehabilitation Protocol after Rotator Cuff Repair

Osteology ◽

10.3390/osteology1010003 ◽

2020 ◽

Vol 1 (1) ◽

pp. 29-38

Author(s):

Alessandra Berton ◽

Sergio De Salvatore ◽

Vincenzo Candela ◽

Gabriele Cortina ◽

Daniela Lo Presti ◽

...

Keyword(s):

Rotator Cuff ◽

Muscle Strength ◽

Internal Rotation ◽

Outcome Measures ◽

Rotator Cuff Repair ◽

External Rotation ◽

Shoulder Function ◽

Rehabilitation Protocol ◽

Patient Reported ◽

Cuff Repair

Rotator cuff tears are a frequent cause of shoulder pain that often require arthroscopic repair. After surgery an intense and well-studied rehabilitation protocol is needed to obtain the complete recovery of shoulder function. Fifty patients, who sustained arthroscopic rotator cuff repair for symptomatic, atraumatic and full-thickness supraspinatus tendon tear, were involved. According to our rehabilitation protocol, during the first four postoperative weeks, the arm was supported with an abduction sling pillow, and pendulum exercises, table slide and active elbow extension and flexion were conceded. Outcome measures (Oxford shoulder score (OSS), simple shoulder test (SST), patient-reported satisfaction), shoulder function (range of motion (ROM) and muscle strength), and MRI examination were evaluated. The mean OSS score and SST score increased from 16 to 30.2 and from 5.3 to 11.4, respectively. Patient-reported satisfaction was 96%. At 12 months, patients improved ROM and muscle strength. Postoperative passive anterior elevation was 176; external rotation averaged 47; internal rotation was 90. Postoperative muscle strength during anterior elevation was 8.3 ± 2.2 kg, internal rotation 6.8 ± 3 kg, external rotation 5.5 ± 2.3 kg. Five out of seven patients with recurrent tears evaluated their results as satisfactory. They reported improvements in terms of OSS and SST mean scores despite recurrent tears; therefore, they did not undergo revision surgery. The delayed postoperative physical therapy protocol was associated with improvements in the outcome measures and shoulder function compared to the preoperatory state and rotator cuff healing demonstrated by MRI.

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